Is mirror therapy combined with a routine physiotherapy protocol effective for children with obstetrical upper brachial plexus palsy?

STUDY DESIGN: Randomized controlled study. INTRODUCTION: Mirror therapy is a rehabilitation strategy based on the repeated use of the mirror illusion and also one of the treatment choice of brachial plexus injuries. PURPOSE: We aimed to determine the effects of mirror therapy combined with a routine rehabilitation program on upper limb motor function in children with obstetric brachial plexus injury. METHODS: Twenty children with obstetric brachial palsy were included in this study. They were randomly allocated to either control (n = 10) or mirror therapy (n = 10) group. The following clinical tools were used to assess the upper extremity function: Active Movement Scale (AMS), Modified Mallet Scale (MMS), Hand Grip Strength (HGS) Test, Finger Grip Strength (FGSM) Test, Box and Block Test (BBT), Nine Hole Peg Test (9-HPT), and goniometric measurement. Both groups received the same routine physiotherapy program for 8 weeks. The study group underwent mirror therapy in addition to the rehabilitation program. RESULTS: The mean age of the study population was 11.35 ± 4.12 years. There was no change in the goniometric values, AMS and MMS scores after the treatment in both groups (p > 0.05), except for the improvement of the wrist extension in the study group (p < 0.05). There was an increase in both HGS and FGS scores in the study group. Only FGS scores improved in the control group after the intervention (p < 0.05). 9-HPT and BBT scores improved in both groups (p < 0.05). All other parameters tested were comparable between the two groups after the treatment. CONCLUSIONS: The results of this study did not show any additional benefits of mirror therapy combined with a rehabilitation protocol compared to routine physiotherapy treatment, but was not adequately powered to do so.

Imputation Methods to Deal With Missing Responses in Computerized Adaptive Multistage Testing.

Routing examinees to modules based on their ability level is a very important aspect in computerized adaptive multistage testing. However, the presence of missing responses may complicate estimation of examinee ability, which may result in misrouting of individuals. Therefore, missing responses should be handled carefully. This study investigated multiple missing data methods in computerized adaptive multistage testing, including two imputation techniques, the use of full information maximum likelihood and the use of scoring missing data as incorrect. These methods were examined under the missing completely at random, missing at random, and missing not at random frameworks, as well as other testing conditions. Comparisons were made to baseline conditions where no missing data were present. The results showed that imputation and the full information maximum likelihood methods outperformed incorrect scoring methods in terms of average bias, average root mean square error, and correlation between estimated and true thetas.

What Information Works Best?: A Comparison of Routing Methods.

There are many item selection methods proposed for computerized adaptive testing (CAT) applications. However, not all of them have been used in computerized multistage testing (ca-MST). This study uses some item selection methods as a routing method in ca-MST framework. These are maximum Fisher information (MFI), maximum likelihood weighted information (MLWI), maximum posterior weighted information (MPWI), Kullback-Leibler (KL), and posterior Kullback-Leibler (KLP). The main purpose of this study is to examine the performance of these methods when they are used as a routing method in ca-MST applications. These five information methods under four ca-MST panel designs and two test lengths (30 items and 60 items) were tested using the parameters of a real item bank. Results were evaluated with overall findings (mean bias, root mean square error, correlation between true and estimated thetas, and module exposure rates) and conditional findings (conditional absolute bias, standard error of measurement, and root mean square error). It was found that test length affected the outcomes much more than other study conditions. Under 30-item conditions, 1-3 designs outperformed other panel designs. Under 60-item conditions, 1-3-3 designs were better than other panel designs. Each routing method performed well under particular conditions; there was no clear best method in the studied conditions. The recommendations for routing methods in any particular condition were provided for researchers and practitioners as well as the limitations of these results.

Differential Item Functioning Detection Across Two Methods of Defining Group Comparisons: Pairwise and Composite Group Comparisons.

This study compares two methods of defining groups for the detection of differential item functioning (DIF): (a) pairwise comparisons and (b) composite group comparisons. We aim to emphasize and empirically support the notion that the choice of pairwise versus composite group definitions in DIF is a reflection of how one defines fairness in DIF studies. In this study, a simulation was conducted based on data from a 60-item ACT Mathematics test (ACT; Hanson & Béguin). The unsigned area measure method (Raju) was used as the DIF detection method. An application to operational data was also completed in the study, as well as a comparison of observed Type I error rates and false discovery rates across the two methods of defining groups. Results indicate that the amount of flagged DIF or interpretations about DIF in all conditions were not the same across the two methods, and there may be some benefits to using composite group approaches. The results are discussed in connection to differing definitions of fairness. Recommendations for practice are made.